标题：烧伤患者感染病原菌分布及耐药性分析

      作者：余孟飞 1，周小仙 1，陈泽慧 1，2，陈安林 1，陈先恋 1，刘清亮 1，左静 2    1.遵义医科大学附属医院医学检验科，贵州 遵义 563003；2.遵义医科大学检验医学院，贵州 遵义 563006

      卷次： 2022年33卷15期

      【摘要】 目的 分析我院近3年烧伤患者感染病原菌分布及耐药性变化，为临床合理选用抗菌药物、减少耐药菌产生及医院感染控制提供依据。方法 收集遵义医科大学附属医院2019—2021年烧伤患者送检标本分离菌株，采用VITEK MS质谱仪和VITEK-2 Compact全自动微生物分析系统进行细菌鉴定与药敏试验，使用WHONET 5.6和SPSS22.0软件统计分析标本种类、菌种类型及主要病原菌药敏结果。结果 共检出病原菌2 136株，其中革兰阳性菌1 103株(51.6%)，革兰阴性菌1 033株(48.4%)，病原菌来源于创面分泌物86.3%，静脉血5.7%，脓液3.1%。检出前3位病原菌依次为金黄色葡萄球菌(26.9 %)、铜绿假单胞菌(9.2%)和大肠埃希菌(8.6%)。在金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)占39.8%，MRSA对庆大霉素、氟喹诺酮类和利福平抗菌药物耐药率<20%，对克林霉素及红霉素耐药率达80.0%左右；对复方新诺明的耐药率分别为10.5%、8.6%、27.5%；未检出利奈唑胺、万古霉素和替考拉宁耐药菌株。铜绿假单胞菌对氨曲南耐药率2019年及2021年均小于30.0%，2020年达40.7%；对头孢吡肟、碳青霉烯类、氨基糖苷类和喹诺酮类耐药率在10.0%左右，其中亚胺培南，由1.8%上升至9.4%。大肠埃希菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星在 2019年均未出现耐药菌株，2020耐药率均为 1.9%，2021年分别为9.9%、1.4%、1.4%；环丙沙星耐药率2019—2021年分别为44.7%、56.4%、67.6%。结论 我院近3年烧伤患者感染的病原菌主要来自创面分泌物，以金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌为主，且多重耐药严重；定期密切监测病原菌分布及耐药变迁是临床合理应用抗菌药物和控制耐药菌发展的有效举措。
      【关键词】 烧伤；感染；病原菌；耐药性；耐药菌
      【中图分类号】 R644 【文献标识码】 A 【文章编号】 1003—6350（2022）15—1962—05

Distribution and drug resistance analysis of pathogenic bacteria in burned patients.
YU Meng-fei 1, ZHOUXiao-xian 1, CHEN Ze-hui 1,2, CHEN An-lin 1, CHEN Xian-lian 1, LIU Qing-liang 1, ZUO Jing 2. 1. Department ofLaboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, CHINA; 2. School ofLaboratory Medicine, Zunyi Medical University, Zunyi 563006, Guizhou, CHINA
【Abstract】 Objective To provide guidance of the rational usage of antibiotics, reduction of drug-resistant strains,and hospital infection control by investigating the distribution and drug resistance of pathogenic bacteria in burned patientswith infection in Affiliated Hospital of Zunyi Medical University in recent three years.Methods Strains of bacteria isolat-ed from burned patients of the hospital from 2019 to 2021 were collected. The bacteria identification and drug sensitivitytest were carried out by VITEK MS mass spectrometer and VITEk-2 Compact automatic microbial analysis system. Sta-tistical analysis was performed to investigate the type of specimens and strains and the resistance rates of major patho-gens by statistical software of WHONET 5.6 and SPSS22.0. Results A total of 2 136 isolates were isolated from 2019to 2021, which were isolated from wound secretion (86.3%), venous blood (5.7%), pus (3.1%), respectively. Amongthem, 1 103 (51.6%) isolates were Gram-positive bacteria and 1 033 (48.4%) were Gram-negative bacteria. The top threepathogens were Staphylococcus aureus (26.9%), Pseudomonas aeruginosa (9.2%), and Escherichia coli (8.6%). Methicil-lin-resistant Staphylococcus aureus (MRSA) accounted for 39.8% of Staphylococcus aureus; the resistance rate of MRSAto gentamicin, fluoroquinolones, and rifampicin antibiotics was less than 20%; the drug resistance rate to clindamycinand erythromycin was about 80.0%; the resistance rates to cotrimoxazole were 10.5%, 8.6%, and 27.5%, respectively; novancomycin, linezolid, or teicoplanin-resistant strains were detected. The drug resistance rate of Pseudomonas aeruginosato amtrionam was less than 30.0% in 2019 and 2021, and reached 40.7% in 2020; the drug resistance rate to cefepime,carbapenems, aminoglycosides, and quinolones was about 10.0%; the resistance rate to imipenem increased from 1.8%to 9.4%. There were no strains of Escherichia coli resistant to piperacillin/tazobactam, imipenem and amikacin found in2019; the resistance rates of Escherichia coli were all 1.9% in 2020, and 9.9%, 1.4%, 1.4% in 2021, respectively; the drugresistance rates of Escherichia coli to ciprofloxacin from 2019 to 2021 were 44.7%, 56.4%, and 67.6% , respectively.